Privacy Policy and Procedures

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION
IS IMPORTANT TO US.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain
the privacy of your health information. We are also required to give you this
Notice about our privacy practices, our legal duties, and your rights
concerning your health information. We must follow the privacy practices that
are described in this Notice while it is in effect. This Notice takes effect
September 1, 2003, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms
of this Notice at any time, provided such changes are permitted by applicable
law. We reserve the right to makes the changes in our privacy practices and the
new terms of our Notice effective for all health information that we maintain,
including health information we created or received before we made the changes.
Before we make a significant change in our privacy practices, we will change
this Notice and make the new Notice available upon request.

You may request a copy of our Notice at
any time. For more information about our privacy practices, or for additional
copies of this Notice, please contact us using the information listed at the
end of this Notice.

USES AND DISCLOSURES OF
HEALTH INFORMATION

We use and disclose health information
about you for treatment, payment, and healthcare operations. For example:

Treatment: We may use or disclose your health
information to a physician or other healthcare provider providing treatment to
you.

Payment: We may use and disclose your health
information to record payment for services we provide to you.

Your
Authorization: In addition to our use of your health
information for treatment, payment or healthcare operations, you may give us
written authorization to use your health information or to disclose it to
anyone for any purpose. If you give us an authorization, you may revoke it in
writing at any time. Your revocation will not affect any use or disclosures
permitted by your authorization while it was in effect.

Unless you give us a written authorization, we cannot use or
disclose your health information for any reason except those described in this
Notice.

To Your Family and Friends: We must
disclose your health information to you, as described in the Patient Rights
section of this Notice. We may disclose your health information to a family
member, friend or other person to the extent necessary to help with your
healthcare or with payment for your healthcare, but only if you agree that we
may do so.

Persons Involved
In Care: We may use or disclose health information to notify, or assist in
the notification of (including identifying or locating) a family member, your
personal representative or another person responsible for your care, of your
location, your general condition, or death. If you are present, then prior to
use or disclosure of your health information, we will provide you with an
opportunity to object to such uses or disclosures. In the event of your
incapacity or emergency circumstances, we will disclose health information
based on a determination using our professional judgment, disclosing only
health information that is directly relevant to the person’s involvement in
your healthcare. We will also use our professional judgment and our experience
with common practice to make reasonable inferences of your best interest in
allowing a person to pick up prescriptions, x-rays, or other similar forms of
health information.

Marketing
Health-Related Services: We will not use your health information
for marketing.

Required by
Law: We may use or disclose your health information when we are
required to do so by law.

Abuse or
Neglect: We may disclose your health information to appropriate authorities
if we reasonably believe that you are a possible victim of abuse, neglect, or
domestic violence or the possible victim of other crimes. We may disclose your
health information to the extent necessary to avert a serious threat to your
health or safety or the health or safety of others.

National Security: We may disclose to
military authorities the health information of Armed Forces personnel under
certain circumstances. We may disclose to authorized federal officials health
information required for lawful intelligence, counterintelligence, and other
national security activities. We may disclose to a correctional institution or
law enforcement official having lawful custody of protected health information
of an inmate or patient under certain circumstances.

Appointment Reminders: We may use or
disclose your health information to provide you with appointment reminders
(such as voicemail messages, postcards, or letters.)

PATIENT RIGHTS Access: You have the right to look at or get copies of your health
information, with limited exceptions. You may request that we provide copies in
a format other than photocopies. We will use the format you request unless we
cannot practicably do so. (You must make a request in writing to obtain access
to your health information. You may obtain a form to request access by using
the contact information listed at the end of this Notice. We may charge you a
reasonable cost-based fee for expenses such as copies and staff time. You may
also request access by sending us a letter to the address at the end of this
Notice. If you request an alternative format, we may charge a cost-based fee
for providing your health information in that format. If you prefer, we will
prepare a summary or an explanation of your health information. There may be a
fee for this service. Contact us using the information listed at the end of
this Notice for a full explanation of our fee structure.)

Disclosure
Accounting: You have the right to receive a list of instances in which we or
our business associates disclosed your health information for purposes, other
than treatment, payment, healthcare operations and certain other activities,
for the last 6 years, but not before April 14, 2003. If you request this
accounting more than once in a 12-month period, we may charge you a reasonable,
cost-based fee for responding to these additional requests.

Restriction: You have the right to request that we place additional
restrictions on our use or disclosure of your health information. We are not
required to agree to these additional restrictions, but if we do, we will abide
by our agreement (except in an emergency).

Alternative
Communication: You have the right to request that we
communicate with you about your health information by alternative means or to
alternative locations. {You must make
you request in writing.} Your request must specify the alternative
means or location, and provide satisfactory explanation how any payments will
be handled under the alternative means or location you request.

Amendment: You have the right to request that we
amend your health information. (Your request must be in writing, and it must
explain why the information should be amended.) We may deny your request under
certain circumstances.

Electronic Notice: If you receive this
Notice on our website or by electronic mail (e-mail), you are entitled to
receive this Notice in written form.

QUESTIONS AND
COMPLAINTS

If you want
more information about our privacy practices or have questions or concerns,
please contact us.

If you are concerned that we may have violated your privacy
rights, or you disagree with a decision we made about access to your health
information or in response to a request you made to amend or restrict the use
or disclosure of your health information or to have us communicate with you by
alternative means or at alternative locations, you may complain to us using the
contact information listed at the end of this Notice. You also may submit a
written complaint to the U.S. Department of Health and Human Services. We will
provide you with the address to file your complaint with the U.S. Department of
Health and Human Services upon request.

We support your right to the privacy of your health
information. We will not retaliate in any way if you choose to file a complaint
with us or with the U.S. Department of Health and Human Services.

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